Less Invasive Decompressive Laminectomy and One-Level Lumbar Fusion in the Setting of Interspinous Fixation: A Retrospective Analysis of 15 Patients.

Hamidreza Aliabadi,Manika S Paul,Barry Chehrazi,Mari Kusumi

doi:10.7759/cureus.17653

Hamidreza Aliabadi, Manika S Paul + Show 2 more

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https://doi.org/10.7759/cureus.17653

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Abstract

Lumbar decompressive laminectomy for spinal stenosis can be performed using a less-invasive, unilateral approach with subperiosteal dissection and decompression by undermining the lamina from the ipsilateral to the contralateral side. A unilateral approach to bilateral decompression can be supplemented with interspinous instrumentation and facet fusion, a combined procedure that has not been studied before. The less-invasive technique appears to be as effective for lumbar stenosis as the traditional lumbar laminectomy. It also causes less blood loss and reduced operating time, and so may benefit patients who are elderly, medically frail, or with multiple comorbidities. Fifteen patients (eight females, seven males) underwent outpatient surgery by the author (HA) using this technique. These patients complained of progressive lower back pain associated with radicular pain exacerbated by prolonged standing or walking with improvement in flexed position of the lumbar spine with decreased walking distance ability. A one-level less-invasive lumbar laminectomy and foraminotomy with facet fusion and interspinous fixation were performed for spinal stenosis in conjunction with a Grade I degenerative spondylolisthesis. These patients all had a single-level facet fusion with bone graft material and local autograft. The approximate surgical time for each patient was between 50 and 80 minutes. The visual analog scale for pain (VAS) score decreased significantly after surgery; patients presented with preoperative VAS scores of 5-10/10 (mean 8.33/10). Postoperative VAS scores were 0-6/10 (mean 2/10), yielding a mean VAS improvement of 76% following surgery. Future analysis should be performed for evaluation of sustained VAS score, Oswestry Disability Index (ODI), Form 36 Health Survey Questionnaire (SF 36), and the Zurich Claudication Questionnaire (ZCQ).

Highlights

A common pathology associated with Grade I degenerative lumbar spondylolisthesis is neurogenic claudication secondary to spinal stenosis
This improvement is comparable to that in studies of pedicle screw fixation; one study showed a visual analog scale for pain (VAS) improvement of 71-73% for posterior-lateral spinal fusion (PSF) in mild degenerative disease [15], with another showing an improvement of 85%, but for a mix of patients with conditions including degenerative spondylolisthesis and spinal stenosis [16]
Open bilateral laminectomies have been performed for such stenosis, but with less invasive approaches, such as the approach used by the surgeon (HA) in these cases, a unilateral approach for bilateral decompression may be undertaken with less resultant surgical trauma or insult

Summary

Introduction

A common pathology associated with Grade I degenerative lumbar spondylolisthesis is neurogenic claudication secondary to spinal stenosis. Lumbar spinal fusion has been the standard of care for the treatment of symptomatic degenerative spondylolisthesis. A prospective randomized controlled trial by Herkowitz et al found that adding fusion was more effective than decompression alone in the treatment of degenerative lumbar spondylolisthesis [4]. Various fusion constructs to treat lumbar spinal stenosis in the setting of degenerative spondylolisthesis have been considered the gold standard [5], but the possibility remains that a limited spinous process stabilization with facet arthrodesis may be sufficient and may spare patients from some of the complications of traditional pedicle screw fixation-fusion procedures

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